cynicism in pediatrics
I saw a little girl who fell out of a second story window. The attending's diagnosis? Failure to fly. (Don't you love the ER?)
topcynicism in internal medicine
Am I a bad person for laughing out loud when I saw this in the chart of a patient with very severe dementia?
history of throwing feces at nurses when not restrainedFri, 30 Jul 2004 top
cross-eyed
I have just realized that I've been wearing my contact lenses backwards for the last several days.
My prescription in my right eye is 1 diopter worse than the left eye. Strangely, my right eye can't seem to tell the difference between -9.5 diopters and -8.5 diopters, but my left eye sure can. This has lead to some serious eye-strain and fatigue, not to mention headaches. I seriously thought that I was going blind.
Heh. It's a good thing I'm not in a field that requires extremely fine visual acuity, like hand surgery. Or opthalmology.
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Tue, 27 Jul 2004 topempathy (or the lack thereof)
A blogger who states he has Asperger syndrome brings up this particular test, in which you try to guess a person's emotion from just the appearance of their eyes.
For more information about Wowbagger the Infinitely Prolonged, consult the Hitchhiker's Guide Project
topparamnesias
Yossarian shook his head and explained that dØjÒ vu was just a momentary infinitesimal lag in the operation of two coactive sensory nerve centers that commonly functioned simultaneously. The chaplain scarcely heard him. He was disappointed, but not inclined to believe Yossarian, for he had been given a sign, a secret, enigmatic vision that he still lacked the boldness to divulge. There was no mistaking the awesome implications of the chaplain's revelation: it was either an insight of divine orientation or a hallucination; he was either blessed or losing his mind. Both prospects filled him with equal fear and depression. It was neither dØjÒ vu, presque vu, nor jamais vu. It was possible that there were other vus of which he had never heard and that one of these other vus would explain succinctly the baffling phenomenon of which he had been both a witness and a part; it was even possible that none of what he though had taken place, really had taken place, that he was dealing with an aberration of memory rather than of perception, that he never really had thought he had seen what he now thought he once did think he had seen, that his impression now that he once had thought so was merely the illusion of an illusion, and that he was only now imagining that he had ever once imagined seeing a naked man sitting in a tree at the cemetery. —from Catch 22 by Joseph Heller
This article explains possible neurobiological mechanisms for the phenomenon of dØjÒ vu, resurrecting pre-Freudian psychiatry.
Man, I kind of wonder if maybe Freud actually set back neuroscience and psychiatry. He was never mentioned in my clinical behavioral science class, nor during my psychiatry rotation. It's as if he never existed. And yet Hollywood continues to portray psychiatrists as Freudian disciples. Anyway.
Google brings up an entry from the Hitchhiker's Guide to the Galaxy as well.
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Mon, 26 Jul 2004 topsword swallowing x-rays
Radiographs of people who have swallowed swords. (Found on #!/usr/bin/girl.)
Just to state the obvious: it would be a really bad idea to take these guys to MRI.
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Mon, 12 Jul 2004 topinstrument ties
Word of advice: even if you don't plan on going into surgery or emergency medicine, don't forget how to suture.
Nothing worse than an attending staring wide-eyed at you as you fumble around in the office with a pair of hemostats, vaguely manipulating some 5-0 Ethicron with some not-so-sterile gloves, in an earnest, but misguided attempt to throw a stitch into a 2.5 cm laceration.
Luckily it wasn't a facial lac.
At least when the patient's family member asked me if I'd ever done this before, I could honestly say "Yes." Even if it had been nearly two years since I had tried to close up a lac.
I can see it now. When I get there, the ER is going to crucify me.
Sun, 11 Jul 2004 topthe lighter side of trach life
Ah, the things you can find on the Internet. How to abuse your newly installed tracheostomy tube. Just what we need. People asphyxiating because they accidentally inhaled a balloon through their trach. Or, even better, aspirating gasoline into their lungs while trying to do the fireball trick.
In case you need to be reminded, don't try any of this at home.
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Sat, 10 Jul 2004 topfilipina nurses on ER
Finally, they try to make ER (the show) more realistic.
While the ED at Cook County Hospital isn't entirely run by Filipina nurses (in contrast to many of the EDs in California), there are definitely a lot more than just one or two or three.
The lack of Indian (South Asian) attending physicians is pretty unrealistic, too.
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Fri, 09 Jul 2004 top18:59 · permalink · add a comment
Sun, 04 Jul 2004 topnothing worse than dead
I checked out Incidental Findings again, after having avoided reading it for a while because it was starting to depress me. Again, I kind of wonder if medical students just end up living a certain kind of life, particularly if they're single and Asian. The parallels with my own four years of sleep-deprived, alcohol-imbued insanity are frightening.
But I digress.
So I was reading then entry entitled ACLS certified, and it reminded me of something my senior resident told me as a 3rd year medical student. In his view, if someone codes, they are, for all intents and purposes, dead, and the whole point of resuscitation is to try to bring them back to life. Hence, since the patient is at that point dead, you really shouldn't worry about whether you're going to hurt them or not. If your chest compressions are breaking ribs, or you are causing burns with the defibrillator, or if you are puncturing all their veins and a panicked attempt to establish access, don't freak out about it. (To quote my senior resident: "If you're not breaking ribs, you're not doing them [chest compressions] right.") Personally, if I were a patient, I'd rather be alive with broken ribs, burns, and/or torn up veins than dead but pristine. Of course, if we're dealing with a geriatric patient here, we start entering the advanced directive conundrum. (That is, the conundrum when the patient has an advanced terminal illness, but there is no advanced directive. What ends up happening sometimes is that you have no choice but to repeatedly code the patient, and sometimes it can get really gruesome since it is unlikely that you are doing any good, but I won't get into that.)
Now, the whole thing above only applies to ACLS, though. The whole idea is that when an adult keels over and stops breathing, chances are they're having a cardiac arrest. (Unless you actually saw them inhale that chunk of filet mignon.) In PALS and in NALS, it's quite different. PALS assumes that the child has something stuck in their windpipe (whether a toy, a piece of food, or water from the swimming pool.) And NALS is an entirely different type of panic. NALS is what freaks me out the most. Here is someone who has just entered the world getting ready to exit it, and nothing freaks me out more than the thought of not being able to resuscitate a newborn. (Well, not being able to resuscitate a kid freaks me out too.)
The thing is, statistically speaking, it's bound to happen. When I was a 3rd year med student doing peds, one of my classmates at another site had a horrific experience coding a 10 yo asthmatic who ended up not making it.
I know the following might seem cold-hearted, but, you know, if it was a 70 yo COPDer that was being coded and they didn't make it, I wouldn't feel as bad. I mean, it sucks a lot, but, honestly, I don't think most people would be surprised. It's a little different when a 45 year old dies, even if they have advanced disease. But it just gets more and more tragic the younger a patient is.
I know that I ought to be treating all my patients completely equally, but I guess my dad's cynicism has permeated me thoroughly. Old people are supposed to die eventually. You try your best to bring them back and keep them there, over and over again on the same night if need be, but if they don't make it, well, everyone has their time. The flip side of this cynicism, though, is my idealism that kids are never supposed to die. Even though the statistics are against me. The things that is especially upsetting though is that a good number of these deaths are preventable, and a huge subset of these are even non-accidental. Yup, this world sucks a lot sometimes.
Sheesh. Now who's depressing whom.
topVA peds
You know the world has gone to shit when people who are still young enough to be technically considered pediatric patients are showing up at the VA.
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